Introduction to Health Psychology

What is good health?

Take a moment to describe what you think being “healthy” or “in good health” entails.

•Psychology – scientific study of behavior and mental processes

•Health Psychology – the subarea within psychology devoted to understanding psychological influences on health and illness and responses to those states.

•Health psychologists study health-related behaviors & mental processes, and apply psychological principles, research, and interventions to the enhancement of health, the prevention and treatment of illness, and shaping of health care policy.

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Early Views of Illness

•Often attributed to “evil spirits” until development of microscope (1600’s) led to discovery of infectious microorganisms àà

•“Biomedical Model” – illness caused by disturbances in biological processes (chemical imbalances, bacteria, viruses, genetics).

•Epidemic infections were major killers

Change in Causes of Death
In 1900

•Flu & pneumonia

•Tuberculosis

•Gastroenteritis

•Cardiovascular disease

•Accidents

•Cancer

•Diphtheria

•Typhoid

•Measles

•Liver disease

•(more infectious disease)

•Versus the following causes in 2000

•Cardiovascular Disease

•Cancer

•Cerebrovascular Disease

•Chronic Pulmonary Disease

•Accidents

•Flu & pneumonia

•Diabetes

•Suicide

•Kidney disease

•Liver disease (more lifestyle related disease)

Twentieth Century

Mind – body association rediscovered.

Freud’s theory that psych. conflict can cause physical symptoms that have no underlying organic basis (e.g. conversion disorders) later led to field of:

Psychosomatic Medicine (1930’sà):

§Particular illnesses believed to be caused by psychological factors

§

Twentieth Century continued

•The growth of behaviorism led to interest in applying the principles of classical and operant conditioning to the treatment of medical problems (e.g. using biofeedback and behavior modification). This approach became known as behavioral medicine.

Behavior is important!

•Changes in health and causes of death not just due to medical advances but also behavioral/psychological and social changes

–Behavioral changes – better hygiene, nutrition and attitudes/awareness

–Social changes – water purification and sewage treatment

–Even today decreases in killers like cancer and CVD are in part due to prevention through behavioral change and earlier detection.

Factors Leading to the Development of Health Psych

•Change in the nature of illness

•Biomedical model unable to fully account for health/illness

•Rising health care costs increased interest in prevention and more effective care

•New technologies increased need for patient counseling

•Greater public interest in good health

•Increased medical acceptance of usefulness of psychology

Health Psychology

•Study of social, behavioral, cognitive, and emotional factors that influence the:

–Maintenance of health

–Development of illness or disease

–Course of illness or disease

–Patient’s and family’s response to illness and disease

–Physician’s diagnosis and care of the patient

•Health psych applies principles and research of clinical, social, developmental, experimental and biopsych areas of psychology and also draws from related areas like community health, occupational therapy, social work etc.

•Biomedical model replaced by a BIOPSYCHOSOCIAL MODEL

•We must take into account the influences of biological, psychological and social “systems” on the individual’s health

Biological Factors

•Genetics

•Physiology

•Gender

•Age or stage of development

•Immune system function

•Nutrition

•Medications

Psychological factors

•Behaviors (both health promoting and health risking)

•Emotions

•Cognitions (thoughts, beliefs, attitudes – including such things like self-efficacy, appraisal of situation, feelings of personal control, optimism)

•Personality

•Stress

•Coping skills

•Adherence to medical advice

Social factors

•Birth cohort or generation

•Peer pressure

•Social support

•Education

•Environmental factors

•Access to healthcare

•Poverty/socioeconomic status

•Ethnic background

•Cultural beliefs, values and customs

•Prejudice, stereotyping and racism

World Health Organization definition:

Health is a complete state of well-being:

•Physical well being

•Mental well being

•Social well being

Health is not merely the absence of disease.

The state of optimum health is called wellness

The Illness-Wellness Continuum
(page 3 in text)

Some Topics of Interest in HP

•Promotion of healthy lifestyles (e.g., diet, exercise, smoking cessation)

•Stress and its effects on functioning

•Patient-practitioner relationships (e.g., reluctance to communicate with provider, treatment noncompliance)

•Adjustment to chronic illnesses (e.g. diabetes)

•Management of the dying patient

•Behavioral contributions to STDs, Cancer, Coronary Heart Disease

•Psychological factors and pain

•Healthcare system and health policy

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Important Contributions of Psychology to Health

•Has provided techniques useful in changing behaviors that affect health and illness.

•Is committed to keeping people healthy rather than only waiting to treat them when they become ill.

•Long history of developing reliable and valid measures for assessing health-related factors.

•Has contributed a solid foundation of scientific methods for studying such behaviors.

Becoming a Health Psychologist

•Health Psych is both a research area and a practice area.

•Doctorate (PhD or PsyD)

•Many programs - See Div. 38’s Web site for a list (linked to syllabus)

•Often, but not always, a track in clinical psychology doctoral programs

•Licensure is needed to practice as a clinical health psychologist (seek out an APA-accredited doctoral program).

•There are also health psych MA programs and health psych related jobs that you can get with just a bachelor’s degree.

Where can you find health psychologists?

•Family practices; Pediatrics

•HIV prevention and treatment

•Pain Centers

•Cardiopulmonary Rehabilitation

•Emergency room

•Spinal cord injury rehabilitation; stroke rehab

•Universities

•Sleep disorders clinics

•Public health and policy agencies

•Infertility clinics

•Oncology and other chronic disease clinics and support groups

•HMOs

•Industry

Research Methods in
Health Psychology

Descriptive Methods

•Case Studies/Reports

–An in-depth study of one person

–Pro: Lots of info, great for rare/special cases

–Con: Can’t generalize

–Health Psych example –

–First cases of AIDS

–

Descriptive Methods

•Naturalistic or participant observation

–Not difficult to design and complete

–Problems: Presence of the observer

–Observer’s bias

•Archival research – historical or secondary analysis of existing data

Descriptive Methods

•Surveys and interviews

–Pro: Easy to collect a lot of data inexpensively

• Range of topics can be covered (actions, beliefs, attitudes, feelings etc)

–Con:

•Rely on self-report

•Phrasing of questions and responses can bias the results

•Sample must be appropriate

Descriptive Methods

•Correlational studies

–Determining the degree of relationship or association between two variables

–e.g., # stressful life events & heart attack

–Correlation coefficient: -1.00 to +1.00

–Pro:

•Shows direction (+ or -) and strength of relationship

•Can examine variables that cannot be experimentally manipulated (e.g., IQ and occupational status).

–Con: Can’t determine causation (just a relationship)

Correlations DO NOT imply causal relationships

Experimental Designs

•Examines differences between experimentally manipulated groups (e.g., one group gets a certain drug and the other gets a placebo) while controlling other variables

•Pro:

–You can determine causality.

•Con:

–Artificial experiment settings can influence behavior

–Can be costly and difficult

– Many variables cannot be experimentally manipulated (e.g., smoke exposure over time).

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Experimental Methods

•Independent Variable

–variable that is manipulated by investigator to determine its effect on one or more dependent variables

•Dependent Variable

–variable measured or observed as the outcome of the study

•Random Assignment to Groups

–each participant has an equal chance of being subjected to any of the conditions

•Often conducted double-blind to avoid bias

Links to more information on the studies we used as examples in our syllabus-

Experiment Example

•40 heterosexual ISU males rated their perceived risk of contracting an STD or AIDs from a single sexual encounter with partners with relatively high risk or low risk sexual histories. Then the researchers manipulated sexual motivation – some males were shown low sex appeal photos of the partners, others saw high sex appeal photos, and all were asked to imagine going home from a bar with the pictured women, then asked to again rate their risk. Those who saw sexy photos lowered their risk ratings!!

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Essay a Day Keeps the Dr. Away

•After baseline phys. Exams, either asthma or arthritis sufferers were randomly assigned to groups. The treatment group wrote a 20 min. essay each day for 3 days about their deepest thoughts and feelings about the most stressful event they had ever experienced. The control group spent the same time writing essays about their plans for the day. A 2^nd checkup revealed

•Treatment- 47% improved, 4% got worse

•Control- 24.3% improved, 21.6% got worse

Quasi-Experimental Studies

•Look like experiments but participants are NOT randomly assigned to groups

•Groups differ from the outset of study

•May not involve true manipulation of an independent variable while holding other things constant

•Cause-effect conclusions cannot be drawn

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Quasi-experiments

–Natural experiments – when a natural event occurs, look at those affected vs those not affected

–Ex post facto studies – subjects assigned to groups based on a pre-existing characteristic like gender, diet, illness, etc.( NOT random assignment)

–Prospective studies – look forward in the lives of people to see if differences at time A are related to differences at time B (e.g. if I measured your hostility levels now and looked at your cardiovascular health in 20 years)

–Retrospective studies – look back at the past history of individuals to see if variables at an earlier time are related to differences at the later time (e.g. did those who developed multiple sclerosis have different childhood illnesses than those without MS?)

Lifespan Studies

•Cross-Sectional Study Designs

–Compares groups at one point in time (e.g., age groups, ethnic groups, disease groups)

–Efficient way to identify possible group differences because you study them at one point in time.

–Disadvantage is that you cannot rule out cohort effects.

•Longitudinal Study Designs

–Gather data on variables over time (e.g. the development of illness or a pattern of behavior over time)

–

Longitudinal Example

•Caspi et al (1997) assessed the personality traits of 18 yr olds that had been part of a long. study since they were toddlers. Certain traits (negative emotion & lack of constraint) predicted health risky behaviors (alcohol abuse, unprotected sex, violence, dangerous driving) when they were 21. These traits were predicted by temperament qualities at age 3 (undercontrol)

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What are Clinical Methods?

•Experiment and experiment– like studies used to evaluate effectiveness of treatments

•Special issues in treatment situations:

–Patient selection criteria

–Possible co-morbidity with other illnesses

–May be receiving other treatments

–Patient cooperation

•Randomized controlled trials (RCTs) are true experiments

•Locality-based intervention vs control groups are examples of quasiexperiments.

•Example: Kelly et al (1992) allocated gay bars in certain towns for peer education whereas bars in matched towns received no intervention. The proportion of gay men engaging in unprotected sex decreased by 1/3 in the intervention towns vs the control towns.

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Genetics Research

•Twin studies comparing the similarity of identical twins vs. the similarity of faternal twins

•Adoption studies – compare traits of adopted children with those of their adoptive vs. their biological parents

Epidemiological Research

The study of the frequency, distribution, and causes of infectious and noninfectious disease in a population based on an investigation of the physical and social environment

Morbidity – how common is a particular disease? A couple different ways of determining this:

• Incidence: the number of new cases in a particular time period

• Prevalence: the total number of existing cases, often expressed as a % of the total population

Mortality refers to the number of deaths due to a particular cause.

Epidemiological Studies

•Determine origins of specific diseases

•Evaluate prevention procedures

Meta-analysis

•Statistical combination of the results of many similar studies. Can help determine what the preponderance of the evidence shows when studies have conflicting results.

•Theory: an attempt to provide an explanation for some kind of behavior

•Model – similar to a theory. Often presented in a series of boxes that attempt to show the thought processes people go through to reach a particular decision.

•Can conduct studies to see if they support the theory or model